The role of NMDA receptor-dependent activity of noradrenergic neurons in attention, impulsivity and exploratory behaviors.

Activity of the brain's noradrenergic (NA) neurons plays a major role in cognitive processes, including the ability to adapt behavior to changing environmental circumstances. Here, we used the NR1DbhCre transgenic mouse strain to test how NMDA receptor-dependent activity of NA neurons influenced performance in tasks requiring sustained attention, attentional shifting and a trade-off between exploration and exploitation. We found that the loss of NMDA receptors caused irregularity in activity of NA cells in the locus coeruleus and increased the number of neurons with spontaneous burst firing. On a behavioral level, this was associated with increased impulsivity in the go/no-go task and facilitated attention shifts in the attentional set-shifting task. Mutation effects were also observed in the two-armed bandit task, in which mutant mice were generally more likely to employ an exploitative rather than exploratory decision-making strategy. At the same time, the mutation had no appreciable effects on locomotor activity or anxiety-like behavior in the open field. Taken together, these data show that NMDA receptor-dependent activity of brain's NA neurons influences behavioral flexibility.

Dysfunctional inhibitory mechanisms in locus coeruleus neurons of the wistar kyoto rat.

BACKGROUND: The noradrenergic nucleus locus coeruleus (LC) has functional relevance in several psychopathologies such as stress, anxiety, and depression. In addition to glutamatergic and GABAergic synaptic inputs, the activation of somatodendritic α2-adrenoceptors is the main responsible for LC activity regulation. The Wistar Kyoto (WKY) rat exhibits depressive- and anxiety-like behaviors and hyperresponse to stressors. Thus, the goal of the present study was to investigate in vitro the sensitivity of α2-adrenoceptors, as well as the glutamatergic and GABAergic synaptic activity on LC neurons of the WKY strain. METHODS: For that purpose patch-clamp whole-cell recordings were done in LC slices. RESULTS: The α2-adrenoceptors of LC neurons from WKY rats were less sensitive to the effect induced by the agonist UK 14 304 as compared to that recorded in the Wistar (Wis) control strain. In addition, the GABAergic input to LC neurons of WKY rats was significantly modified compared to that in Wis rats, since the amplitude of spontaneous GABAergic postsynaptic currents was reduced and the half-width increased. On the contrary, no significant alterations were detected regarding glutamatergic input to LC neurons between rat strains. CONCLUSIONS: These results point out that in WKY rats the inhibitory control exerted by α2-adrenoceptors and GABAergic input onto LC neurons is dysregulated. Overall, this study supports in this animal model the hypothesis that claims an imbalance between the glutamatergic-GABAergic systems as a key factor in the pathophysiology of depression.

Altered neuronal activity and differential sensitivity to acute antidepressants of locus coeruleus and dorsal raphe nucleus in Wistar Kyoto rats: a comparative study with Sprague Dawley and Wistar rats.

The Wistar Kyoto rat (WKY) has been proposed as an animal model of depression. The noradrenergic nucleus, locus coeruleus (LC) and the serotonergic nucleus, dorsal raphe (DRN) have been widely implicated in the ethiopathology of this disease. Thus, the goal of the present study was to investigate in vivo the electrophysiological properties of LC and DRN neurons from WKY rats, using single-unit extracellular techniques. Wistar (Wis) and Sprague Dawley (SD) rats were used as control strains. In the LC from WKY rats the basal firing rate was higher than that obtained in the Wis and SD strain, and burst firing activity also was greater compared to that in Wis strain but not in SD. The sensitivity of LC neurons to the inhibitory effect of the α2-adrenoceptor agonist, clonidine and the antidepressant reboxetine was lower in WKY rats compared to Wis, but not SD. Regarding DRN neurons, in WKY rats burst activity was lower than that obtained in Wis and SD rats, although no differences were observed in other firing parameters. Interestingly, while the sensitivity of DRN neurons to the inhibitory effect of the 5-HT1A receptor agonist, 8-OH-DPAT was lower in the WKY strain, the antidepressant fluoxetine had a greater inhibitory potency in this rat strain compared to that recorded in the Wis group. Overall, these results point out important electrophysiological differences regarding noradrenergic and serotonergic systems between Wis and WKY rats, supporting the utility of the WKY rat as an important tool in the research of cellular basis of depression.

Fagerström tolerance questionnaire y heavy smoking index. ¿Cuál de los dos test es suficiente para determinar la dependencia en la clínica diaria? / The Fagerström tolerance questionnaire & the heavy smoking index. Which of them is necessary to assess the dependence in the clinical practice?

Objetivo. Conocer la correlación existente entre el Fagerström Tolerance Questionnaire (FTQ) y el Heavy Smoking Index (HSI) para la valoración de la dependencia de la nicotina en la práctica clínica habitual. Métodos. Estudio prospectivo realizado durante el año 2010 en una consulta hospitalaria y en una de atención primaria. Se incluyeron en el estudio 792 fumadores, 437 (55,18%) hombres y 355 (44,82%) mujeres con una edad media de 45,3 {13} y 38,6 {11,8} años, respectivamente. Para valorar la correlación existente entre ambos test se ha utilizado el coeficiente de correlación de Spearman. Resultados. El consumo medio de cigarrillos/día fue de 25,0 y la concentración media de CO de 19,14 ppm. El valor medio del FTNC fue de 7,12 y del HSI 4,39. Ambos test presentan una alta correlación con un coeficiente de Spearman de 0,82 (p=0,000), que es significativa en los grupos con alta y baja dependencia (p=0,000), pero no en el grupo con dependencia moderada (p=0,176). La correlación en función del género fue alta tanto para hombres (r=0,771) como para mujeres (r=0,881). La correlación por grupos de edad fue alta para los tres grupos etarios estudiados: <25 años (r=0,828), 25-49 años (r=0,813) y >50 años (r=0,796). Conclusiones. Existe una buena correlación global entre el Fagerström Tolerance Questionnaire (FTQ) y el Heavy Smoking Index (HSI), que no se modifica en función de variables como edad o género. Por niveles de dependencia, la correlación es buena en pacientes con dependencia alta o moderada y no significativa en el grupo con dependencia moderada (AU)

Objective. To know what is the correlation between Fagerström Tolerance Questionnaire (FTQ) and the Heavy Smoking Index (HSI) in order to examine nicotine dependence in current clinical practice. Methods. Prospective study made in 2010’s tobacco specific medical clinic and primary care. It includes 792 smokers, 437 (55,18%) men and 355 (44,82%) women, with a mean of years old 45,3 [13] and 38,6 [11,8] respectively. In order to assess the existent correlation between both tests we used Spearman’s Correlation Coefficient. Results. The average daily consumption of cigarettes was 25.5 and the mean concentration of CO was 19.14 ppm. The mean value of FTNC was 7.12 and HSI 4.39. Both tests present a high correlation, with a Spearman coefficient of 0.82 (p=0.000). The correlation is significant in high and low dependency groups (p=0.000), but not in the group with moderate dependency (p=0.176). Gender-wise, the correlation was high for men (r=0.771) and women (p=0.881). Regarding age groups, correlation was high for the three groups analyzed: <25 years (r=0.828), 25-49 years (r=0.813) and >50 years (r=0.796). Conclusions. There is a respectable global correlation between Fagerström Tolerance Questionnaire (FTQ) and the Heavy Smoking Index (HSI). This correlation does not vary in front of variables like age or gender. When considering dependency levels, the correlation is significant among high or low dependency and non-significant within the moderate dependency group (AU)

alpha(2)-Adrenoceptors mediate the acute inhibitory effect of fluoxetine on locus coeruleus noradrenergic neurons.

So far, the mechanisms underlying the action of selective serotonin reuptake inhibitors, such as fluoxetine, are not completely understood. Thus, to clarify if fluoxetine has any effect on noradrenergic transmission, we measured the spontaneous firing rate of noradrenergic neurons in the locus coeruleus both in vivo and in vitro using single-unit extracellular recordings. In anesthetized rats, fluoxetine (2.5-20 mg/kg, i.v.) reduced the firing rate in a dose-dependent manner, reaching a maximal inhibition of 55 +/- 5% with respect to the basal value. This effect was not only completely reversed by the alpha(2)-adrenoceptor antagonist, RX 821002 (0.2 mg/kg, i.v.), but also prevented by previous application of both idazoxan (0.05 and 0.1 mg/kg, i.v.) and RX 821002 (6.25 microg/kg, i.v). Furthermore, when noradrenaline was depleted from axon terminals by means of the injection of alpha-methyl-DL-tyrosine (250 mg/kg, i.p.) 24 h prior to the experiment, fluoxetine failed to inhibit locus coeruleus activity. In rat brain slices, perfusion with fluoxetine (100 microM for 5 min) did not modify the firing rate of locus coeruleus neurons (n = 7). We conclude that fluoxetine inhibits locus coeruleus neurons in vivo through a mechanism involving noradrenaline interacting with alpha(2)-adrenoceptors. However, the lack of effect on brain slices would seem to indicate that afferents to the nucleus may be involved in the observed inhibitory effect.

Effects of sodium valproate and carbamazepine on food competition aggression in pigeons.

Valproate and carbamazepine (CAR) have been proposed as adjunct alternatives for the control of aggression in psychiatric patients, although no definite conclusions have been reached. We examined the effects of these drugs on food competition offensive aggression and other behaviors in high- and low-aggression food-restricted pigeons. These were divided into pairs containing previously ranked high-aggression (N = 10 pairs) and low-aggression females (N = 10 pairs). In Experiment 1, a pigeon in each pair of high- and low-aggression subjects was treated daily with an oral dose of sodium valproate (50 mg kg-1 mL saline-1) for 15 days. The other animal received the vehicle. On days 1, 7, and 15, food competition trials (10 min) were performed 60 min after treatment. In Experiment 2, one pigeon in each pair was treated daily with an oral dose of CAR (20 mg kg-1 mL saline-1) for 15 days. Each pair was submitted to a food competition trial on days 1, 7, and 15 of treatment. Valproate (15 days of treatment) selectively decreased the time spent in offensive aggression (control: 102.7 +/- 9.3 vs valproate: 32.7 +/- 9.2 s; P < 0.001, ANOVA-2-TAU) of high-aggression pigeons. This was also the case for 7 and 15 days of CAR treatment (control: 131.5 +/- 8.9 vs CAR: 60.4 +/- 5.3, P < 0.01, and control: 122.7 +/- 7.1 vs CAR: 39.1 +/- 5.2; P < 0.001, ANOVA-2-TAU, respectively). Thus, the two anticonvulsive drugs have a similar effect on food competition aggression in pigeons.

Effects of sodium valproate and carbamazepine on food competition aggression in pigeons

Valproate and carbamazepine (CAR) have been proposed as adjunct alternatives for the control of aggression in psychiatric patients, although no definite conclusions have been reached. We examined the effects of these drugs on food competition offensive aggression and other behaviors in high- and low-aggression food-restricted pigeons. These were divided into pairs containing previously ranked high-aggression (N = 10 pairs) and low-aggression females (N = 10 pairs). In Experiment 1, a pigeon in each pair of high- and low-aggression subjects was treated daily with an oral dose of sodium valproate (50 mg kg-1 mL saline-1) for 15 days. The other animal received the vehicle. On days 1, 7, and 15, food competition trials (10 min) were performed 60 min after treatment. In Experiment 2, one pigeon in each pair was treated daily with an oral dose of CAR (20 mg kg-1 mL saline-1) for 15 days. Each pair was submitted to a food competition trial on days 1, 7, and 15 of treatment. Valproate (15 days of treatment) selectively decreased the time spent in offensive aggression (control: 102.7 ± 9.3 vs valproate: 32.7 ± 9.2 s; P < 0.001, ANOVA-2-TAU) of high-aggression pigeons. This was also the case for 7 and 15 days of CAR treatment (control: 131.5 ± 8.9 vs CAR: 60.4 ± 5.3, P < 0.01, and control: 122.7 ± 7.1 vs CAR: 39.1 ± 5.2; P < 0.001, ANOVA-2-TAU, respectively). Thus, the two anticonvulsive drugs have a similar effect on food competition aggression in pigeons.

Relación entre la abstinencia puntual a los quince días y el abandono del tabaco a los seis meses / Relationship between punctual abstinence at fifteen days and giving up smoking at six months

Objetivo: valorar la capacidad predictiva del resultado a los 15, 30,60 y 90 días en el resultado obtenido a medio plazo (180 días), en una cohorte de fumadores tratados con terapia sustitutiva (TSN), bupropión (BPP) o terapia combinada (TC), según la normativa SEPAR, en las condiciones clínicas habituales. Pacientes y métodos: estudio multicéntrico, prospectivo, longitudinal, en pacientes mayores de 18 años. Se efectuaron controles a los15, 30, 60, 90 y 180 días, determinándose la abstinencia mediante autorrespuesta y CO en aire espirado conjuntamente. Se ha calculado la probabilidad de haber estado abstinente a los 15, 30, 60 y 90 días, frente a la probabilidad de no haberlo estado a los seis meses (odds ratio y límites de confianza exactos del 95%). En todos los contrastes el nivel de significación estadística aceptado fue de p < 0,05. Resultados: Se incluyeron 904 fumadores, 476 varones y 428 mujeres, edad media de 42,51 ± 10,09 años. No se observó que sexo, edad, comorbilidad, número de cigarrillos/día, historia de paquetes-año, intentos previos de abandono, nivel de dependencia o la concentración inicial de CO guardaran relación con el éxito o fracaso terapéutico. Para el total de los pacientes, solamente permanecer abstinente a los quince días se relacionó de forma independiente con mayor probabilidad de éxito en el tratamiento en el análisis de regresión: la OR ajustada fue 3,11,(LC 95% de 2,80-3,46). El modelo predice el 65,14 % de los eventos. Conclusión: Los resultados del estudio indican que la abstinencia a los 15 días es el predictor más consistente del resultado final (AU)

Objective: To identify the predictive values of smoking abstinence at 15, 30, 60 and 90 days in the outcome at the 180 days in smokers treated with NRT, bupropion or combined therapy (NRT + bupropión)according with the SEPAR guidelines. Patients and methods: multicenter, longitudinal and prospective study in smokers older than 18 years. Evaluations were made at 15,30, 60, 90, and 180 days. In each visit, abstinence was determined by SR and CO measurement in expired air. The probability of abstinence at 15, 30, 60 and 90 days has been calculated against the probability of not have been at 180 days (odds ratio and confiance interval 95 %). The statistic significance level are p < 0,05. Results: The study group included 904 smokers, 476 men and 428 women, with a mean age of 42.5±10.1 years. None of the personal variables(gender, age, comorbility, number of cigarettes smoked per day, Fagerström, CO in aspired air) are predictors of abstinence. Subjects who smoked during weeks 1 and 2 were significantly less likely to be abstinent from smoking at 180 days than those who did not smoke during weeks 1 and 2. The abstinence at 15 days are the better predictive variable with the outcomes at the 180 days (OR 3.11, CI 95%: 2.80-3.46). Conclusión: The 15 days abstinence were the better predictive variable of outcomes at the 180 days (AU)

[Veracity of smokers' reports of abstinence at smoking cessation clinics]. / Veracidad de la respuesta de los fumadores sobre su abstinencia en las consultas de deshabituación tabáquica.

OBJECTIVE: To assess the reliability of smokers' response as criteria for measuring abstinence and the necessity or not of confirming abstinence with carbon monoxide (CO) measurement. PATIENTS AND METHODS: A multicenter, prospective, longitudinal study was carried out on patients over 18 years of age from 5 smoking cessation clinics who underwent treatment with nicotine or bupropion. When the patient attended the clinic at 15, 30, 60, 90, and 180 days, abstinence was checked by self-reporting and expired-air CO levels. Sensitivity, specificity, and positive, negative, and overall predictive value of patient reporting, measured CO levels, and the 2 procedures in combination were calculated. RESULTS: A total of 904 smokers (476 men and 428 women) with a mean (SD) age of 42.51 (10.09) years were enrolled in the study. Of the 904 patients that made up the study population, 820, 776, 687, 719, and 679, respectively, attended the scheduled visits to check abstinence. Self-reported point-prevalence abstinence at 15 days was 74.5% and at 180 days was 57.6% while abstinence determined by expired-air CO was 75.7% and 59.4% respectively. Results according to self-reporting, CO measurement, and the 2 methods in combination were not significantly different (P<.05) at any of the points in time. Neither sensitivity nor specificity showed significant differences in relation to patient variables. CONCLUSION: The reliability of self-reported abstinence from smoking is high. Measurement of CO is therefore not essential, although it could be advisable for motivating patients rather than as a way of confirming abstinence.

Veracidad de la respuesta de los fumadores sobre su abstinencia en las consultas de deshabituación tabáquica / Veracity of smokers´ report of abstinence at smoking cessation clinics

OBJETIVO: Valorar la fiabilidad de la respuesta del fumador como criterio de medida de abstinencia y el carácter de prescindible o indispensable de la determinación de monóxido de carbono (CO) para corroborar dicho criterio. PACIENTES Y MÉTODOS: Se ha realizado un estudio multicéntrico, prospectivo y longitudinal en pacientes mayores de 18 años que acudieron a 5 consultas de tabaquismo y a quienes se pautó tratamiento sustitutivo con nicotina o bupropión. Se efectuaron controles a los 15, 30, 60, 90 y 180 días. En cada control se determinó la abstinencia mediante la respuesta dada por el paciente, la determinación de CO en aire espirado y ambos procedimientos conjuntamente. Se calcularon la sensibilidad, especificidad, valor predictivo positivo, negativo y global de la respuesta dada por el paciente respecto de la determinación de CO. RESULTADOS: Se incluyó en el estudio a 904 fumadores (476 varones y 428 mujeres), con una edad media (± desviación estándar) de 42,51 ± 10,09 años. De los 904 acudieron a los controles programados 820, 776, 687, 719 y 679, respectivamente, que constituyen la población objeto de estudio. La abstinencia puntual a los 15 y 180 días determinada por la respuesta de los pacientes fue del 74,5 y del 57,6%, y mediante determinación de CO en aire espirado del 75,7 y del 59,4%, respectivamente. No se observaron diferencias significativas (p < 0,05) entre los 3 procedimientos a los 15, 30, 60, 90 y 180 días. Ni la sensibilidad ni la especificidad mostraron diferencias estadísticamente significativas entre las distintas categorías de las variables. CONCLUSIÓN: La fiabilidad de la respuesta dada por los pacientes sobre la abstinencia tabáquica es elevada. Por ello la determinación de CO es prescindible y no resulta indispensable, si bien en el seguimiento del proceso puede ser recomendable como factor motivador para el paciente más que como una forma de comprobar la abstinencia

OBJECTIVE: To assess the reliability of smokers’ response as criteria for measuring abstinence and the necessity or not of confirming abstinence with carbon monoxide (CO) measurement. PATIENTS AND METHODS: A multicenter, prospective, longitudinal study was carried out on patients over 18 years of age from 5 smoking cessation clinics who underwent treatment with nicotine or bupropion. When the patient attended the clinic at 15, 30, 60, 90, and 180 days, abstinence was checked by self-reporting and expired-air CO levels. Sensitivity, specificity, and positive, negative, and overall predictive value of patient reporting, measured CO levels, and the 2 procedures in combination were calculated. RESULTS: A total of 904 smokers (476 men and 428 women) with a mean (SD) age of 42.51 (10.09) years were enrolled in the study. Of the 904 patients that made up the study population, 820, 776, 687, 719, and 679, respectively, attended the scheduled visits to check abstinence. Self-reported point-prevalence abstinence at 15 days was 74.5% and at 180 days was 57.6% while abstinence determined by expired-air CO was 75.7% and 59.4% respectively. Results according to self-reporting, CO measurement, and the 2 methods in combination were not significantly different (P<.05) at any of the points in time. Neither sensitivity nor specificity showed significant differences in relation to patient variables. CONCLUSION: The reliability of self-reported abstinence from smoking is high. Measurement of CO is therefore not essential, although it could be advisable for motivating patients rather than as a way of confirming abstinence

Patient-reported benefits of rizatriptan compared with usual non-triptan therapy for migraine in a primary care setting.

The purpose of this open-label study was to compare rizatriptan with usual non-triptan therapy for migraine in patients who had never received a triptan. Patient-reported outcomes were examined for a prestudy migraine attack and after three consecutive study attacks, the first and third treated with rizatriptan 10 mg wafer and the second with usual non-triptan therapy. A total of 97 patients (83% women; mean age 39 years) completed the study. Two-thirds of patients reported severe or total disability during migraine attacks. All comparisons between rizatriptan therapy and usual non-triptan therapy significantly favoured rizatriptan (p < or = 0.01). Headache relief by 2 hours was reported by 78-83% of patients after rizatriptan and by 46-48% of patients after usual therapy; 41-47% and 12-18%, respectively, were pain free at 2 hours. Patient satisfaction and migraine-specific quality-of-life scores were also significantly better for attacks treated with rizatriptan. At study end, 62% and 17% of patients were very or completely satisfied with rizatriptan and usual non-triptan therapy, respectively. Among those patients who worked for pay, therapy with rizatriptan significantly reduced absenteeism and improved the amount and quality of time at work compared with usual non-triptan therapy. Allowing patients to have experience with rizatriptan may improve the level of medical care for migraine attacks.

NO synthase inhibitors reduce opioid desensitization in rat locus coeruleus neurons in vitro.

The aim of this study was to examine by electrophysiological techniques whether nitric oxide (NO) is involved in the development of desensitization to the opioid agonist Met5-enkephalin (ME) in locus coeruleus neurons from rat brain slices. Bath perfusion with ME (0.05-1.6 microM) caused a concentration-dependent reduction in the firing rate of locus coeruleus cells, whereas perfusion with a high concentration of ME (10 microM) desensitized the inhibitory effect of subsequent ME (0.8 microM) applications. However, in slices perfused with the NO synthase inhibitors 7-NI (100 microM), L-NAME (100 microM) or L-NA (100 microM) the ME (10 microM)-induced opioid desensitization was strongly attenuated. The effect of L-NAME was prevented by administration of L-arginine (100 microM). These results suggest that nitric oxide may contribute to opioid desensitization in locus coeruleus neurons.

[The self-efficacy of school principals and their influence on smoking prevention at school]. / Nivel de autoeficacia de los directores escolares e influencia del mismo sobre la prevención del tabaquismo en la escuela.

INTRODUCTION: Self-efficacy is a psychological variable that has scarcely been taken into account in approaches to smoking prevention among young people. The self-efficacy of school principals may play a role in schools that truly comply with their mission of preventing or limiting the influence of smoking among students. OBJECTIVE: To know the degree to which self-efficacy of school principals influences behavior toward smoking in their schools, assessed as attitude of students toward smoking, the degree of compliance with official anti-smoking laws and the content of anti-smoking campaigns undertaken. MATERIAL AND METHODS: A questionnaire was designed and sent to 3050 school principals to assess their level of self-efficacy in reducing the percentage of smoking students, the behavior of students and teachers with regard to smoking, the degree of compliance at school with anti-smoking laws and the content of anti-smoking campaigns undertaken. The data were codified and analyzed using appropriate statistical tests for each type of variable. RESULTS: Mean self-efficacy scores of the school principals for reducing the prevalence of smoking in their centers was 38.7 (SD 30.86) points on a scale of 100. The score was 40.18 (SD 30.8) where anti-smoking campaigns were undertaken and 34.31 (SD 30.43) where they were not. The mean score was 40.09 (SD 30.8) where anti-smoking posters were visible and 36.68 (SD 30.75) where no posters were hung(p < 0.05). The mean score of centers whose principals reported requiring compliance with anti-smoking laws was 39.78 (SD 30.8) and for schools where the law was not followed the score was 36.12 (SD 30.9) (p < 0.05). CONCLUSIONS: Schools whose principals have higher levels of self-efficacy display better general levels of functioning and a higher level of compliance with law and anti-smoking curricula. It seems necessary to direct efforts toward strategies to improve principals' self-efficacy for the prevention of smoking.

[The physician and the patient in the decision to quit smoking. Effect of the initiative on the result of the intervention]. / El médico y el paciente en la toma de decisión del abandono del tabaco. Repercusión de la iniciativa en el resultado de la intervención.

INTRODUCTION: The results obtained from treatment of smoking addiction are not all that might be desired, such that continued investigation of the various factors that determine treatment success or failure are necessary. The aim of this study was to know the influence of health care providers in the smoking cessation process. MATERIAL AND METHODS: We performed a prospective, longitudinal study of patients at a primary care facility and a specialized unit. Two types of intervention were performed: minimal intervention with patients with a low level of dependence and nicotine patch substitution treatment (Nicotinell) (NST) in patients with moderate-to-high dependence. RESULTS: The total number of smokers enrolled was 427: 206 at the primary care facility (87 who requested treatment and 119 to whom enrollment was recommended) and 21 at the respiratory medicine unit (79 who requested treatment and 142 to whom enrollment was recommended). One year after minimal intervention, abstinence was 36.8% (27.2%-47.4%) at the primary care center and 41.8% (31.9%-52.2%) at the specialized unit (p > 0.05). Abstinence in the NST group at each center was 35.3% (24.1%-47.8%) and 35.5% (25.8%-46.1%), respectively (p > 0.05). With minimal intervention, 40% (16.3%-67.7%) of those who had requested enrollment had quit smoking one year after starting, versus 36.3% (32.1%-46.9%) of those to whom it had been recommended (p > 0.05); in the NST group, the percentages were 33.3% (24.4%-43.2%) and 39.3% (26.5%-53.2%) (p > 0.05). The percentage of abstinence among smokers in pre-contemplation phase was 28.4% (18.5%-40.1%) one year after starting; among those in the contemplation phase, abstinence at one year was 49.2% (36.6%-61.9%) (p < 0.05). The patients whose enrollment was the result of physician recommendation had better outcomes (odds ratio of 0.244 [95% CI: 0.097-0.616]). CONCLUSIONS: Intervention among smokers should be as strong among those who ask for help as among those who have not yet contemplated quitting; progress to another phase in the abandonment process, so that efforts to achieve total cessation can be approached at a later time, should be considered a therapeutic success.

[Two-month results are predictors of outcome in a smoking cessation program]. / Valor predictivo de la abstinencia tabáquica a los 2 meses de tratamiento.

BACKGROUND: The supportive smoking cessation counseling (SSCC) and nicotine replacement therapy (NRT) have been proved to be an effective aid to smoking cessation. The aim of this study was to determine whether the results obtained in a two-month treatment program to helping smokers quit by means of supporting smoking cessation counseling or nicotine replacement therapy included in the routine medical care, can be considered as predictors of success in the long term (one year). SUBJECTS AND METHOD: A longitudinal and prospective study has been carried out, being included in the program all smoker patients who went a primary or specialist unit (n = 357) during a six-month term. The SSCC was carried out in those patients with a low nicotine dependence (Fagerström test < 7) or those who had not got a preparation stage yet. The NRT was tested in those patients with high nicotine dependence (Fagerström >= 7). RESULTS: 32 patients (9%) of the 357 did not turn up to the established controls,being thus considered as hopeless cases. The one-year study was completed by 177 patients in the SSCC group and 148 in the NRTgroup. Abstinence had been achieved by 39.2% of the SSCC group and by 36.2% of theNRT group 12 months later. Previously, in the SSCC group the observed abstinence after two months that the beginning of the program was 34% (27.4-40.7) and in the NRT group was 52.1% (44.5-59.8). The patients who were abstinents after two months of the beginning of the program were 19 times more likely to remain abstinent after a year (odds ratio, 19.4), showing in the SSCC group a sensitivity of 72.4% and a specificity of 90.7%, and in the NRT group the sensitivity was 93.2% and the specificity of 71.2%. CONCLUSIONS: The results observed after two months of the beginning of the program are predictors of outcome and can allow modify the therapeutic attitude with the aim of achieve best rates of success.

Nivel de autoeficacia de los directores escolares e influencia del mismo sobre la prevención del tabaquismo en la escuela / The self-efficacy of school principals and their influence on smoking prevention at school

INTRODUCCIÓN: La autoeficacia es una variable psicológica escasamente tenida en cuenta hasta el momento a la hora de abordar estrategias para la prevención del tabaquismo entre los jóvenes. La autoeficacia de los directores escolares puede influir en que los centros educativos cumplan realmente con su misión de prevenir o limitar la influencia del tabaco entre los jóvenes. OBJETIVO: Conocer en qué medida influye la autoeficacia de los directores escolares en la conducta ante el tabaco en sus centros, valorada ésta en función de la actitud de los alumnos ante el tabaco, del grado de cumplimiento de la legislación oficial antitabaco y de los contenidos educativos antitabaco que se imparten. MATERIAL Y MÉTODOS: Se ha realizado una encuesta entre 3.050 directores escolares en la que se estudió el nivel de autoeficacia de los directores para reducir el porcentaje de alumnos fumadores, así como la conducta de los alumnos y profesores ante el tabaco, el grado de cumplimiento de la legislación oficial antitabaco en los centros y los contenidos antitabaco que se imparten. Los datos fueron codificados y tratados mediante las pruebas estadísticas oportunas en función de la naturaleza de las variables. RESULTADOS: La puntuación global media de la autoeficacia de los directores para conseguir disminuir la prevalencia del tabaquismo en su centro fue de 38,7 (desviación estándar [DE], 30,86) puntos en una escala de 0 a 100. En los centros en los que se abordan temas antitabaco, la puntuación es de 40,18 (DE, 30,8) y en los centros donde no se hace es de 34,31 (DE, 30,43) (p < 0,05). La puntuación media en los centros con carteles antitabaco es de 40,09 (DE, 30,8), mientras que en aquellos que no los exhiben es de 36,68 (DE, 30,75) (p < 0,05). La puntuación media de los centros cuyos directores afirman exigir el cumplimiento de la legislación oficial antitabaco es de 39,78 (DE, 30,8) y la de los centros que no la exigen es de 36,12 (DE, 30,9) (p < 0,05). CONCLUSIONES: Los centros cuyos directores presentan mayores niveles de autoeficacia tienen un mejor funcionamiento global y un mayor grado de cumplimiento de la legislación oficial y de los programas curriculares. Parece necesario dirigir esfuerzos hacia estrategias destinadas a mejorar el nivel de autoeficacia de los directores escolares para la prevención del tabaquismo en los centros escolares (AU)

El médico y el paciente en la toma de decisión del abandono del tabaco. Repercusión de la iniciativa en el resultado de la intervención / The physician and the patient in the decision to quit smoking

INTRODUCCIÓN: Los resultados obtenidos en el tratamiento del tabaquismo no son todo lo satisfactorios que sería de desear, por lo que resulta necesario continuar realizando investigaciones acerca de los múltiples factores que pueden determinar su éxito o su fracaso. El objetivo de nuestro estudio ha sido conocer la influencia del profesional sanitario en el proceso de deshabituación tabáquica. MATERIAL Y MÉTODOS: Hemos realizado un estudio prospectivo, longitudinal, en una consulta de atención primaria y otra de atención especializada. Se llevaron a cabo dos tipos de intervención: intervención mínima en pacientes con una dependencia baja, y tratamiento sustitutivo con parches de nicotina (Nicotinell®) (TSN) en los pacientes con dependencia de moderada a alta. RESULTADOS: El total de participantes en el estudio fue de 427 fumadores, 206 en la consulta de atención primaria (87 incluidos a petición propia y 119 a propuesta médica) y 221 en la consulta de neumología (79 a petición propia y 142 a propuesta médica). Al año de la intervención la abstinencia con la intervención mínima fue del 36,8 por ciento (27,2-47,4 por ciento) en atención primaria y del 41,8 por ciento (31,9-52,2 por ciento) en la especializada (p > 0,05), y en el grupo de la TSN del 35,3 por ciento (24,1-47,8 por ciento) y del 35,5 por ciento (25,8-46,1 por ciento), respectivamente (p > 0,05). Con la intervención mínima, al año abandonaron el tabaco el 40 por ciento (16,3-67,7 por ciento) de los que solicitaron ser incluidos, frente al 36,3 por ciento (32,1-46,9 por ciento) (p > 0,05) de los que se incluyeron por propuesta médica, y con la TSN los porcentajes respectivos fueron del 33,3 por ciento (24,4-43,2 por ciento) y del 39,3 por ciento (26,5-53,2 por ciento) (p > 0,05). El porcentaje de abstinencia observado entre los fumadores en fase de precontemplación fue, al año del inicio de la intervención, del 28,4 por ciento (18,5-40,1 por ciento), y entre los que estaban en fase de contemplación, del 49,2 por ciento (36,6-61,9 por ciento) (p < 0,05). Los pacientes que fueron incluidos en el programa de deshabituación a propuesta médica obtuvieron mejores resultados, presentando una odds ratio de 0,244, con un intervalo de confianza del 95 por ciento de 0,097-0,616.CONCLUSIONES: La intervención sobre el tabaquismo debe realizarse con el mismo hincapié en quienes solicitan ayuda y en los que todavía no se plantean el abandono del tabaco, y se debe contemplar el progreso de fase en el proceso de abandono de tabaco como un éxito terapéutico para, con un abordaje posterior, conseguir la cesación total del hábito tabáquico (AU)

Attitudes of teachers about tobacco prevention at school.

BACKGROUND: To know the smoking habits of the Spanish teachers, the anti-smoking teaching and the influence on the smoking habits of the students. METHODS: A cross-sectional study was conducted using a self-administrated and anonymous questionnaire. Of the he questionnaires addressed to the headmasters of 8,000 school centers selected as a random sample among the 18,457 existing in Spain, 3,050 valid answers were received. RESULTS: 29.7% of Spanish teachers are smokers, smoking significantly more (p < 0.001; 95% C.I.) in Secondary education (37.2 +/- 15.9%) than in Primary education (26.2 +/- 19.4%) and 7% smoke in front of the pupils, significantly more in state schools (p < 0.05) and in Secondary education (p < 0.001). There are positive correlations between the percentage of smoking teachers and the percentage of pupils who tasted tobacco (p < 0.001) or are regular smokers (p < 0.001), and also between the percentage of teachers who smoke in front of the pupils and the percentage of students who tried tobacco (p < 0.001) or smoke regularly (p < 0.001). In the school centers which apply the non-smoking regulation or teach antitobacco contents, the percentage of teachers smoking in front of pupils is significantly lower (p < 0.001). CONCLUSIONS: The attitude of teachers has an influence on the students; headmasters must ask for the application of non-smoking regulation and include health education contents in school curriculum.

Leprosy elimination campaign, Amazonas-Brazil 1997.

A leprosy elimination campaign (LEC) was carried out in 15 endemic areas of Amazonas State, Brazil, in 1997. The LEC concentrated effort to detect leprosy cases during a multi-vaccination national campaign for serious public health problems other than leprosy, such as polio, diphtheria, hepatitis, measles, etc. The national campaign involved intensive population mobilization, giving a valuable opportunity to examine people for leprosy. The LEC personnel included 2964 individuals (municipal and state health workers and community volunteers), distributed in 688 health units and 53 reference health centres. As a result of the LEC, 74,814 person-to-person communications in the community were given; 10,297 clinical skin examinations were conducted, and 40 new leprosy cases were detected on the day of the campaign in urban areas of the municipalities. This total was low, compared to results in other states of Brazil, possibly due to the development of health education activities and regular community services in the state of Amazonas since 1987 and to the early implementation of WHO multiple drug therapy (MDT) from 1982 onwards. Despite the fact that the LEC was carried out only in the urban areas of the municipalities, the finding of no cases of leprosy in 7 out of 15 of them was surprising and may indicate that the prevalence of hidden cases of leprosy is not all that high, at least in these areas of the Amazonas State.